11 total
Accident benefits claim dismissed as applicant failed to prove injuries warranted removal from the Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.
The applicant argued that his chronic pain and carpal tunnel syndrome warranted removal from the MIG.
The Tribunal found that the applicant failed to establish a causal link between the accident and his carpal tunnel syndrome, and that there was insufficient medical evidence of a functional impairment caused by chronic pain.
Consequently, the applicant's injuries were deemed predominantly minor, and his claims for a physiotherapy treatment plan and interest were dismissed.
Application for accident benefits dismissed; applicant failed to prove entitlement to MIG removal or non-earner benefits.
The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline (MIG).
The applicant claimed entitlement to a non-earner benefit, various treatment plans, and removal from the MIG due to pre-existing conditions, psychological impairments, and chronic pain syndrome.
The Licence Appeal Tribunal found that the applicant failed to establish that her pre-existing conditions precluded recovery within the MIG, nor did she prove accident-related psychological impairments or chronic pain syndrome.
The Tribunal also dismissed the claim for a non-earner benefit, finding insufficient evidence of a complete inability to carry on a normal life.
As the applicant remained in the MIG and the limits were exhausted, the disputed treatment plans were denied.
Accident benefits claim largely dismissed; only $89.95 awarded for a cognitive training application subscription.
The applicant sought entitlement to statutory accident benefits for chiropractic and massage services, cognitive devices, and physiatry and orthopaedic assessments following a 2019 motor vehicle accident.
The adjudicator found that the applicant failed to prove the treatment plans for chiropractic and massage services were reasonable and necessary, noting a lack of recommendation from her treating physicians and conclusions from assessors that she had reached maximum medical improvement.
The adjudicator partially approved the treatment plan for cognitive devices, awarding $89.95 for a Lumosity subscription but denying the cost of a tablet, as the applicant did not establish why a cell phone could not be used.
The requests for physiatry and orthopaedic assessments were denied as they were not recommended by treating practitioners and were duplicative of an already approved chronic pain assessment.
Application for accident benefits dismissed; applicant failed to prove injuries warranted removal from the Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming his physical and psychological injuries warranted removal from the Minor Injury Guideline (MIG).
The adjudicator found that the applicant's injuries were predominantly minor soft tissue strains, relying on the respondent's independent medical examination and the applicant's own family doctor records.
The applicant failed to provide compelling evidence of chronic pain or psychological impairment sufficient to justify removal from the MIG.
Consequently, the claims for treatment plans exceeding the $3,500 MIG limit and for an award were dismissed.
Applicant held to Minor Injury Guideline limits but awarded income replacement benefits for 104 weeks.
The adjudicator found that the applicant failed to prove his injuries fell outside the Minor Injury Guideline (MIG), as the medical evidence did not establish a diagnosis of chronic pain with functional impairment under the AMA Guides criteria.
Consequently, the disputed treatment plans were denied because the MIG limits were exhausted.
However, the adjudicator determined that the applicant was entitled to income replacement benefits for the first 104 weeks post-accident, as a functional abilities evaluation demonstrated he could not meet the lifting requirements of his pre-accident employment as a delivery driver.
Interest was awarded on the overdue benefits.
Application for accident benefits dismissed; injuries fell within the Minor Injury Guideline and non-earner benefit denied.
The applicant sought accident benefits following a motor vehicle accident, which the respondent insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).
The applicant argued for removal from the MIG due to chronic pain, but the Tribunal found insufficient evidence of functional limitations or psychological impairment to warrant removal.
The Tribunal also dismissed the applicant's claim for a non-earner benefit, noting a lack of evidence demonstrating a complete inability to carry on a normal life.
Finally, the Tribunal found the respondent provided sufficient medical reasons for denying the disputed treatment plans within the required timelines.
The application was dismissed in its entirety.
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline limits.
The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the funding limits had been exhausted.
The applicant argued that pre-existing psychological and physical conditions, as well as chronic pain, warranted removal from the MIG.
The Tribunal found insufficient evidence that the pre-existing conditions prevented maximal medical recovery within the MIG limits, noting the applicant's functionality improved post-accident and diagnostic tests showed no significant injuries.
The application was dismissed, and claims for treatment plans, interest, and a special award were denied.
Tribunal partially approves physical therapy treatment plan but denies subsequent plans and special award.
The applicant sought statutory accident benefits following a motor vehicle accident, disputing the denial of three treatment plans for physical therapy and psychological services, as well as claiming a special award under s. 10 of O. Reg. 664.
The Tribunal found that the June 2018 physical therapy plan was reasonable and necessary to help the applicant transition to a home exercise program, but dismissed the claims for the November 2018 physical therapy plan and the psychological services plan due to insufficient evidence.
The claim for a special award was also dismissed as the insurer's conduct was not found to be excessive or unreasonable.
Application for accident benefits dismissed; applicant failed to prove injuries fell outside the Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a concussion, post-concussion syndrome, and chronic pain, and that pre-existing conditions prevented her recovery under the Minor Injury Guideline (MIG).
The respondent denied the benefits, arguing her injuries were predominantly minor.
The Tribunal found the applicant failed to prove she sustained a concussion or chronic pain, giving little weight to her family doctor's diagnosis which lacked objective testing.
The Tribunal also found no evidence that her pre-existing conditions affected her recovery.
Consequently, the applicant remained subject to the MIG and was not entitled to the disputed physiotherapy benefits or interest.
Applicant awarded non-earner benefits due to severe psychological impairment but denied disputed medical benefits.
The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including non-earner benefits (NEBs) and medical benefits for physiotherapy and a chronic pain assessment.
The respondent insurer denied the benefits.
The Licence Appeal Tribunal found that the applicant suffered a complete inability to carry on a normal life due to severe psychological impairment resulting from the accident, which continuously prevented her from engaging in her pre-accident activities of caring for her children and pursuing her vocational goals.
The Tribunal awarded NEBs of $185.00 per week and interest.
However, the Tribunal dismissed the claims for physiotherapy and a chronic pain assessment, finding insufficient evidence that they were reasonable and necessary, as the applicant's impairment was fundamentally psychological rather than physical.
Application for non-earner benefits dismissed as applicant failed to prove complete inability to carry on a normal life.
The applicant sought a non-earner benefit following a motor vehicle accident.
The Tribunal applied the Heath test and found that the applicant failed to prove a complete inability to carry on a normal life.
The Tribunal preferred the respondent's medical and occupational therapy assessments, which concluded the applicant could perform her normal life activities, over the applicant's expert evidence, which lacked cogent explanation connecting her limitations to a complete inability to carry on a normal life.
The application was dismissed.
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